Stereotactic Radiosurgery for Postoperative Metastatic Surgical Cavities: A Critical Review and International Stereotactic Radiosurgery Society (ISRS) Practice Guidelines.

Details

Serval ID
serval:BIB_E19753FE5B0D
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Stereotactic Radiosurgery for Postoperative Metastatic Surgical Cavities: A Critical Review and International Stereotactic Radiosurgery Society (ISRS) Practice Guidelines.
Journal
International journal of radiation oncology, biology, physics
Author(s)
Redmond K.J., De Salles AAF, Fariselli L., Levivier M., Ma L., Paddick I., Pollock B.E., Regis J., Sheehan J., Suh J., Yomo S., Sahgal A.
ISSN
1879-355X (Electronic)
ISSN-L
0360-3016
Publication state
Published
Issued date
01/09/2021
Peer-reviewed
Oui
Volume
111
Number
1
Pages
68-80
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
The purpose of this critical review is to summarize the literature specific to single-fraction stereotactic radiosurgery (SRS) and multiple-fraction stereotactic radiation therapy (SRT) for postoperative brain metastases resection cavities and to present practice recommendations on behalf of the ISRS.
The Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach to search for manuscripts reporting SRS/SRT outcomes for postoperative brain metastases tumor bed resection cavities with a search end date of July 20, 2018. Prospective studies, consensus guidelines, and retrospective series that included exclusively postoperative brain metastases and had at minimum 100 patients were considered eligible.
The Embase search revealed 157 manuscripts, of which 77 were selected for full-text screening. PubMed yielded 55 manuscripts, of which 23 were selected for full text screening. We deemed 8 retrospective series, 1 phase 2 prospective study, 3 randomized controlled trials, and 1 consensus contouring paper appropriate for inclusion. The data suggest that SRS/SRT to surgical cavities with prescription doses of 30 to 50 Gy equivalent effective dose (EQD) 2 <sub>10</sub> , 50 to 70 Gy EQD2 <sub>5</sub> , and 70 to 90 EQD2 <sub>2</sub> are associated with rates of local control ranging from 60.5% to 91% (median, 80.5%). Randomized data suggest improved local control with single-fraction SRS compared with observation and improved cognitive outcomes compared with whole-brain radiation therapy (WBRT). The toxicity of SRS/SRT in the postoperative setting was limited and is reviewed herein.
Although randomized data raise concern for poorer local control after resection cavity SRS than WBRT, these findings may be driven by factors such as conservative prescription doses used in the SRS arm. Retrospective studies suggest high rates of local control after single-fraction SRS and hypofractionated SRT for postoperative brain metastases. With a superior neurocognitive profile and no survival disadvantage to withholding WBRT, the ISRS recommends SRS as first-line treatment for eligible postoperative patients. Emerging data suggest that fractionated SRT may provide superior local control compared with single-fraction SRS, in particular, for large tumor cavity volumes/diameters and potentially for patients with a preoperative diameter greater than 2.5 cm.
Keywords
Brain Neoplasms/radiotherapy, Brain Neoplasms/secondary, Cognition/radiation effects, Cranial Irradiation, Dose Fractionation, Radiation, Humans, Meningeal Neoplasms/etiology, Practice Guidelines as Topic, Radiosurgery/adverse effects
Pubmed
Open Access
Yes
Create date
11/05/2021 9:52
Last modification date
13/10/2021 6:42
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